Related Experiment Videos
[Use of Ommaya CSF reservoir for refractory chronic subdural hematoma]
M Sato1, K Iwatsuki, C Akiyama
1Department of Neurosurgery, Toyonaka Municipal Hospital, Osaka, Japan.
Insights
This study presents an Ommaya reservoir method for refractory chronic subdural hematoma in patients with severe comorbidities. The technique proved effective, reducing reoperations and enabling early patient mobility.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Chronic subdural hematoma (CSH) can be challenging to manage, particularly in patients with severe comorbidities.
- Standard treatments like irrigation and drainage may be insufficient for refractory cases.
Observation:
- Ten patients with refractory CSH and significant comorbidities (e.g., cerebral infarction, liver cirrhosis, thrombocytopenia, parkinsonism, heart disease, spinocerebellar degeneration) were treated.
- After initial treatment failure, an Ommaya cerebrospinal fluid (CSF) reservoir was implanted for intermittent drainage.
Findings:
- Seven patients recovered to their pre-illness condition.
- One patient died from myocardial infarction; two with parkinsonism experienced partial dependency.
- Complications included minor bleeding and reservoir occlusion, but reoperation was avoided.
Implications:
- The Ommaya reservoir offers a viable, less invasive approach for managing refractory CSH in medically complex patients.
- This method facilitates early postoperative mobilization and avoids repeat surgical interventions.
- It highlights a potential strategy for improving outcomes in a challenging patient population.
Abstract:
Ten patients with refractory chronic subdural hematoma were the subjects of this paper. All patients had severe diseases influencing the clinical course of chronic subdural hematoma, such as cerebral infarction, liver cirrhosis, thrombocytopenia, severe parkinsonism, severe heart disease, and spino-cerebellar degeneration. They were first treated in a usual manner; irrigation and drainage of the hematoma cavity. After recurrence of the hematoma, an Ommaya CSF reservoir was put into place and whenever the volume of the hematoma increased the reservoir was punctured. Postoperatively, 7 patients returned to the same conditions as they had before the onset. However, one patient died of myocardial infarction and 2 patients with parkinsonism could not maintain the condition they had before the onset of their disease, resulting in their partially dependent state. Complications were minor bleeding in one patient and an occlusion of the reservoir in another patient. By using this method reoperation was unnecessary, and the patients were able to move early in the post-operative period. This method was suitable for refractory chronic subdural hematoma with severe disease influencing its clinical course.